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Adjusting oral glycopyrrolate medication for hyperhidrosis to reflect seasonal temperature variations.

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Adjusting oral glycopyrrolate medication for hyperhidrosis to reflect seasonal temperature variations.

Dermatol Ther. 2020 Aug 29;:e14249

Authors: García-Souto F, Del Boz J, Polo-Padillo J

Abstract
The condition of most patients with hyperhidrosis (HH) is known to worsen with increased temperature. However, most prior studies of oral glycopyrrolate (OGly) for the treatment of HH have assumed a stable treatment protocol, without taking into account seasonal variations in temperature. The main aim of this study is to evaluate the outcomes derived from performing a seasonal adjustment of the dose of OGly for patients with HH. A prospective study of patients who began OGly for HH, and maintained treatment for at least one year, was performed. All patients had experienced treatment failure with oral oxybutynin. All were recommended to vary the dose of medication according to the time of year. Of the thirty-five patients included in the study, twenty (57.14%) varied the dose. Those with palmar and plantar HH had a greater propensity to do so. The patients who varied the dose according to the time of year were significantly more likely to report an “Excellent” response after 12 months of treatment. The frequency of adverse effects was 71.4% with no significant differences among the study groups. However, there was a significantly higher proportion of adverse effects other than oral xerosis in the group that did not vary the dose. This article is protected by copyright. All rights reserved.

PMID: 32860330 [PubMed – as supplied by publisher]

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Survival study of treatment adherence by patients given oral glycopyrrolate for hyperhidrosis following treatment failure with oral oxybutynin.

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Survival study of treatment adherence by patients given oral glycopyrrolate for hyperhidrosis following treatment failure with oral oxybutynin.

Dermatol Ther. 2020 Aug 21;:

Authors: Del Boz J, García-Souto F, Rivas-Ruiz F, Polo-Padillo J

Abstract
Oral anticholinergics such as oxybutynin (OOx) and glycopyrrolate (OGly) are frequently used in the management of hyperhidrosis. Although OOx is considered currently the anticholinergic drug of first choice, OGly is a safe and effective alternative if OOx fails. The aim of this study was to identify the main variables associated with treatment adherence by patients receiving OGly, for whom previous treatment with OOx had failed. A prospective study was conducted of patients with hyperhidrosis receiving treatment with OGly in the period 2012-19. Epidemiological variables, treatment details, effectiveness and adverse effects were recorded. A total of 58 patients (41 women), with a mean age of 35.9 years, were included in the study. The median follow-up period was 32 months. At 3 months, 70.7% of the patients had responded to treatment (excellent response: 75.6%), and adverse effects were reported by 70.7%. At 12 months, 53.4% had responded (excellent response: 74.2%), with adverse effects in 70.9%. The variables associated with poorer adherence were affected areas: palms of the hands, soles of the feet and armpits. The only variable associated with greater adherence was the generalised presence of hyperhidrosis. Our results provide valuable insights into the outcomes achieved when OGly is used to treat hyperhidrosis. This article is protected by copyright. All rights reserved.

PMID: 32827198 [PubMed – as supplied by publisher]

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Tolerance of Oral Oxybutynin in The Treatment Of Hyperhidrosis.

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Tolerance of Oral Oxybutynin in The Treatment Of Hyperhidrosis.

Dermatol Ther. 2020 Aug 14;:

Authors: Del Boz Gonzalez J, Barón DR, Millán-Cayetano JF, de Troya Martin M

Abstract
BACKGROUND: Oral oxybutynin (OOx) is an effective and safe treatment for the treatment of hyperhidrosis (HH). However, in some patients a loss of efficacy during prolonged treatment has been observed. Analysis of these cases could enable us to identify patients susceptible to OOx tolerance. An alternative treatment might then be considered.
OBJECTIVES: To assess tolerance to OOx in the treatment of HH. Secondarily, to assess epidemiological data and the duration of efficacy, together with the probable causes of any loss in this respect.
METHODS: Retrospective study of patients who started treatment with OOx for HH during the period 2007-2017 and who either abandoned this treatment due to loss of efficacy or needed higher daily doses to maintain the initial efficacy. Epidemiological data were collected, the duration of the efficacy of OOx was recorded and the possible causes of loss of efficacy were considered.
RESULTS: The development of tolerance was suspected in 18 patients (8.5%) of the 211 who had previously responded to OOx. Thirteen patients abandoned OOx due to its lack of efficacy and five had to increase the dose in order to maintain efficacy. In seven patients, tolerance to the drug appeared in the first year of treatment, while in the remaining eleven, the tolerance appeared later.
CONCLUSIONS: Most patients achieved and maintained good control of HH with long-term OOx. However, in some cases the efficacy of the drug decreases. The study analysis did not produce findings enabling us to predict a loss of treatment efficacy. This article is protected by copyright. All rights reserved.

PMID: 32794595 [PubMed – as supplied by publisher]

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Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: a systematic review.

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Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: a systematic review.

J Am Acad Dermatol. 2020 Aug 08;:

Authors: Galadari H, Galadari I, Smit R, Prygova I, Redaelli A

Abstract
BACKGROUND: Botulinum neurotoxin type A has been used for the treatment of hyperhidrosis.
OBJECTIVE: To perform a systematic review of the literature to identify evidence on the treatment approaches and outcomes associated with abobotulinumtoxinA (aboBoNT-A) treatment of hyperhidrosis.
METHODS: Embase, MEDLINE and the Cochrane Library were searched for relevant observational studies (OSs), randomized controlled trials (RCTs) and non-RCTs. There were no date or country restrictions. Bibliographies of review articles and recent congress proceedings (2017-2019) were also searched. Articles were screened using predefined eligibility criteria and relevant data were extracted.
RESULTS: Of 191 unique articles identified, 23 were considered relevant (3 OSs, 10 non-RCTs and 10 RCTs). These articles provided data on axillary (13), palmar (7) and forehead (1) hyperhidrosis, compensatory hyperhidrosis of the back (1), Frey’s syndrome (1) and diabetic gustatory sweating (1). All studies reported that aboBoNT-A reduced sweating and no serious adverse events were observed. Patient satisfaction was high and improvements to quality of life were observed following aboBoNT-A treatment.
LIMITATIONS: Variability in the injection technique when comparing data across studies.
CONCLUSION: This study describes a range of treatment approaches and demonstrates positive outcomes of aboBoNT-A treatment for multiple types of hyperhidrosis.

PMID: 32781184 [PubMed – as supplied by publisher]

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Clinical practice guideline for primary care providers in the management of antidepressant-induced hyperhidrosis: A quality improvement project.

Clinical practice guideline for primary care providers in the management of antidepressant-induced hyperhidrosis: A quality improvement project.

J Am Assoc Nurse Pract. 2020 Aug 07;:

Authors: Thompson S, Johnson D, Lindgren T, Compton L, Chen JL

Abstract
BACKGROUND: Antidepressant-induced excessive sweating (ADIES) is a side effect that occurs in approximately 22% of patients taking antidepressant medications and can negatively affect patient medication adherence.
LOCAL PROBLEM: Primary care providers may not have adequate knowledge of ADIES management. The aims of this project were to increase primary care provider’s overall perceived knowledge related to ADIES, improve confidence in the management of ADIES, and gather input on the perceived usefulness of the initial clinical practice guideline (CPG) for ADIES management.
METHODS: This quality improvement (QI) project consisted of two phases. Phase 1 included the development of a CPG for the pharmacologic management of ADIES based on processes recommended by the Institute of Medicine.
INTERVENTIONS: Phase 2 of the project consisted of a pretest-posttest design pilot of the guideline via a “Lunch and Learn” educational session at a Federally Qualified Health Care Center located in the Northern California.
RESULTS: The results indicated that after exposure to the CPG and participation in the educational program about the guideline, there was an overall significant improvement in provider knowledge and confidence about identification and management of ADIES in their practice.
CONCLUSIONS: Although small in scope, this QI project provides important avenues for further implementation and dissemination of the guideline to manage ADIES. The potential for improved patient care and medication adherence support the usefulness of the implementation of this guideline in other locations.

PMID: 32773537 [PubMed – as supplied by publisher]

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Hyperhidrosis and Aesthetics.

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Hyperhidrosis and Aesthetics.

Handb Exp Pharmacol. 2020 Jul 30;:

Authors: Wang JV, Saedi N, Zachary CB

Abstract
When one considers the avalanche of new indications and uses for botulinum toxins, it is truly surprising that this has all happened in such a short time. And the safety and dependability of these products are profound, when used appropriately. There is still much to be discovered about the potential of this agent when you contemplate the profound non-cosmetic benefits reported by clinicians and scientists from around the world. The mechanism of action has been studied in depth, and yet the benefits appreciated by people with chronic migraine or major depressive disorder, for instance, are unlikely to be explained by our current mechanistic understanding. Given that these toxins control acetylcholine at the motor end plates, and given that acetylcholine is central to practically every cell in the body, it will not be surprising to find that botulinum toxin researchers will be enjoying many decades of fruitful studies. The advent of the non-surgical aesthetic physician has helped push the clinical utilization of botulinum toxins well beyond its original adoption by oculoplastic surgeons in their patients with blepharospasm. We can expect that the next edition of this book to have a dozen or more new indications which will surprise us all.

PMID: 32728993 [PubMed – as supplied by publisher]